The European Drug Report 2018: Trends and Developments provides a timely insight into Europe’s drug problems and responses. The European Monitoring Centre for Drug and Drug Addiction (EMCDDA) flagship report is built on a thorough review of European and national data that highlights emerging patterns and issues. This year it is accompanied online by 30 Country Drug Reports and resources containing full data arrays and graphics, allowing an overview for each country.

Cocaine. Indications are that cocaine supply has increased along with purity, with signs of rising use and an increase in cocaine users seeking treatment.

Fentanyl and new opioids: Five fentanyl derivatives were investigated in 2017. These substances were available in a number of novel forms including nasal sprays. They were also sometimes found mixed with other drugs, such as heroin, cocaine or fake medicines, with the consequence of users often being unaware that they were consuming the substance. Overall, 38 new opioids have been detected on Europe’s drug market since 2009 — including 13 reported for the first time in 2017. This includes 28 fentanyl derivatives, 10 of which were reported for the first time in 2017.

Synthetic cannabinoids: are increasingly linked to health problems and the largest group of new substances monitored by the EMCDDA and are becoming increasingly chemically diverse, with 179 detected since 2008 — including 10 reported in 2017. In the United Kingdom, use of synthetic cannabinoids among prisoners is of particular concern. A survey conducted in 2016 in UK prisons found 33 % of the 625 inmates reported the use of ‘Spice’ in the last month; in comparison, 14 % reported last month cannabis use.

Naloxone: Responding to opioid overdose: the role of naloxone Prisons: an important setting for implementing responses.

Heroin: seizures in terms of quantity declines. The discovery of several laboratories for converting morphine to heroin in the Netherlands, Spain and the Czech Republic in recent years suggests that some heroin is manufactured in Europe. According to available trend data, the number of first-time heroin clients more than halved from a peak in 2007 to a low point in 2013 before stabilising in recent years.

Overdose: It is estimated that at least 7,929 overdose deaths, involving one or more illicit drug, occurred in the European Union in 2016. This rises to an estimated 9,138 deaths if Norway and Turkey are included, representing a 4 % increase from the revised 2015 figure of 8,749; the EU situation is overall stable compared with 2015. As in previous years, the United Kingdom (34 %) and Germany (15 %) together account for around half of the European total. The most recent data show an increase in the number of heroin-related deaths in Europe, notably in the United Kingdom, where the majority of overdose deaths (87 %) involved some form of opioid.

MDMA: increased production and seizures. Until recently, in many countries, MDMA prevalence had been on the decline from peak levels attained in the early to mid-2000s. In recent years, however, monitoring sources suggest stabilisation or increased use of MDMA in some countries.

Other drugs: ketamine and GHB remain low: Seizures of other illicit drugs are reported in the European Union, including around 1,800 seizures of LSD (lysergic acid diethylamide) in 2016, amounting to 97, 000 units. The overall number of LSD seizures has almost doubled since 2010, although the quantity seized has fluctuated.

New benzodiazepines: The EMCDDA is currently monitoring 23 new benzodiazepines — 3 of which were detected for the first time in Europe in 2017. Some new benzodiazepines are sold as tablets, capsules or powders under their own names. In other cases, counterfeiters use these substances to produce fake versions of commonly prescribed anti-anxiety medicines, such as diazepam and alprazolam, which are sold directly on the illicit drug market. While the number of seizures of benzodiazepines decreased in 2016 compared with 2015, the quantity seized increased significantly. During 2016, more than half a million tablets containing new benzodiazepines such as diclazepam, etizolam, flubromazolam, flunitrazolam and fonazepam were seized — an increase of about two-thirds on the number reported in 2015.